The regulation requires doctors to perform the surgeries when asked to do so – including on children – even if it is their medical opinion that the procedure could end up harming the patient.

Dozens of lawmakers voiced their objections to the mandate, saying that it could end up harming the “most vulnerable.”

“Children are some of the most vulnerable in our population, and this rule strips doctors of their ability to counsel and advise the best course of medical care in their professional judgment if they believe gender transition procedures to be harmful,” an Oct. 7 letter to Secretary of Health and Human Services Sylvia Burwell from 47 members of Congress stated.

Over the summer, the Department of Health and Human Services announced that health providers could not refuse treatment for “gender transition” services if they were asked for them.

There is no clear religious exemption in the mandate. Religious health providers like the Franciscan Alliance hospital network and the Christian Medical & Dental Associations, represented by the Becket Fund for Religious Liberty, have filed a lawsuit against the mandate. Five states – Texas, Kansas, Kentucky, Nebraska, and Wisconsin – joined the lawsuit.

The mandate could apply to over 900,000 physicians, the HHS has estimated.

Last Friday, 47 members of Congress signed a letter to Secretary Burwell outlining their concerns with the mandate. Rep. Joe Pitts (R-Pa.), chair of the House Energy and Commerce Committee’s Health Subcommittee, led the group.

“First, this rule for the first time in history requires doctors to perform gender transition procedures or treatments on patients including children, even if the doctor believes the procedures could be harmful,” the members wrote. If doctors refuse to obey the mandate, they could be subject to “massive financial penalties and even job loss,” they added.

The evidence is not conclusive that gender transition is healthy, and some studies show it can cause harm to adults long after a surgery, the letter insisted.

“HHS’ own experts have acknowledged that the clinical literature is ‘inconclusive’ on whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria, and that some studies have ‘reported harms,’” the letter noted.

For instance, guidance from a group cited by the HHS – the World Professional Association for Transgender Help – listed studies showing that for the vast majority of children with gender dysphoria, the experience is only temporary.

Another report released over the summer by the journal The New Atlantis agreed, finding that “only a minority of children who experience cross-gender identification will continue to do so into adolescence or adulthood.”

Among its findings were that “compared to the general population, adults who have undergone sex-reassignment surgery continue to have a higher risk of experiencing poor mental health outcomes. One study found that, compared to controls, sex-reassigned individuals were about 5 times more likely to attempt suicide and about 19 times more likely to die by suicide.”

Johns Hopkins University, once a pioneer in sex reassignment surgery, has since ended the practice, finding that it was actually damaging to those who undergo it.

In light of studies like these showing possible harm for those undergoing gender transition, the HHS should not be coming down on one side of the debate by mandating such procedures, the letter insisted.

“Sensitive, difficult medical decisions should be between a family and their doctor, not government bureaucrats,” Lori Windham, senior counsel of the Becket Fund for Religious Liberty, stated in the letter.

“The government continues to speak out of both sides of its mouth,” she continued. “The military rightly gives doctors freedom to care for patients according to their medical judgment because it acknowledges the risks of transgender medical procedures, particularly for children; yet HHS tramples on doctors’ medical judgment, even for potentially harmful procedures for children.”